Risk of thyroid cancer in a lung cancer screening population of the National Lung Screening Trial according to the presence of incidental thyroid nodules detected on low-dose chest CT

Purpose@#This study evaluated thyroid cancer risk in a lung cancer screening population according to the presence of an incidental thyroid nodule (ITN) detected on low-dose chest computed tomography (LDCT). @*Methods@#Of 47,837 subjects who underwent LDCT, a lung cancer screening population according to the National Lung Screening Trial results was retrospectively enrolled. The prevalence of ITN on LDCT was calculated, and the ultrasonography (US)/fine-needle aspiration (FNA)–based risk of thyroid cancer according to the presence of ITN on LDCT was compared using the Fisher exact or Student t-test as appropriate. @*Results@#Of the 2,329 subjects (female:male=44:2,285; mean age, 60.9±4.9 years), the prevalence of ITN on LDCT was 4.8% (111/2,329). The incidence of thyroid cancer was 0.8% (18/2,329, papillary thyroid microcarcinomas [PTMCs]) and was higher in the ITN-positive group than in the ITN-negative group (3.6% [4/111] vs. 0.6% [14/2,218], P=0.009). Among the 2,011 subjects who underwent both LDCT and thyroid US, all risks were higher (P<0.001) in the ITNpositive group than in the ITN-negative group: presence of thyroid nodule on US, 94.1% (95/101) vs. 48.6% (928/1,910); recommendation of FNA according to the American Thyroid Association guideline and Korean Thyroid Imaging Reporting and Data System guideline, 41.2% (42/101) vs. 2.4% (46/1,910) and 39.6% (40/101) vs. 1.9% (37/1,910), respectively. @*Conclusion@#Despite a higher risk of thyroid cancer in the LDCT ITN-positive group than in the ITN-negative group in a lung cancer screening population, all cancers were PTMCs. A heavy smoking history may not necessitate thorough screening US for thyroid incidentalomas.

A Case of Sepsis Caused by Cellulitis in a Patient with Rheumatoid Arthritis after Tocilizumab Treatment

Tocilizumab, a humanized monoclonal antibody against the interleukin-6 receptor, is therapeutically effective in patients diagnosed with rheumatoid arthritis (RA) compared with placebo. However patients treated with tocilizumab are at increased risk of several adverse effects including anaphylaxis and serious infections that may lead to hospitalization or death. Therefore, the risks and benefits of treatment with tocilizumab should be considered carefully and close monitoring of patients for development of signs and symptoms of side effects is required during and after treatment. Here, we report on a rare case of anaphylaxis and severe sepsis caused by cellulitis in a patient with RA after tocilizumab treatment.

Identification of streptococcus dysgalactiae subsp. equisimilis from septic knee by 16S rRNA gene sequencing / 고신대학교의과대학학술지

Septic arthritis is the infection of a joint by an infectious agent, leading to arthritis. It is therefore important to identify and treat the correct bacteria in septic arthritis. However, accurate identification of bacteria by conventional methods is difficult because of the distinct biochemical characteristics of individual bacteria. This case report aims at assessing septic arthritis caused by Streptococcus dysgalactiae subsp. equisimilis(SDSE) using nucleotide sequences and discusses the associated treatment. Here, Streptococcus agalactiae was determined to be the causative bacteria for septic arthritis in a 77 year-old woman using the conventional method of hemolysis pattern interpretation and morphology. However, nucleotide sequence analysis of 16S ribosomal RNA revealed that SDSE was the causative strain. 16S rRNA gene sequencing can correctly identify bacteria strains that are difficult to be identified by traditional method, and this correct identification can provide patients with the opportunity for adequate treatment using the proper antibiotics.

Phasic Changes in Bladder Compliance During Filling Cystometry of the Neurogenic Bladder

OBJECTIVE: To investigate phasic changes during filling cystometry that most accurately represent detrusor properties, regardless of other factors affecting detrusor contractility. METHODS: Seventy-eight patients (59 males, 19 females; mean age, 48.2 years) with spinal cord injuries were enrolled. Urodynamic studies were performed using a normal saline filling rate of 24 mL/min. We calculated bladder compliance values of the detrusor muscle in each of three filling phase intervals, which divided the filling cystometrogram into three phases referable to the cystometric capacity or maximum cystometric capacity. The three phases were sequentially delineated by reference to the pressure-volume curve reflecting bladder filling. RESULTS: Bladder compliance during the first and second phases of filling cystometry was significantly correlated with overall bladder compliance in overactive detrusors. The highest coefficient of determination (r2=0.329) was obtained during the first phase of the pressure-volume curve. Bladder compliance during all three phases was significantly correlated with overall bladder compliance of filling cystometry in underactive detrusors. However, the coefficient of determination was greatest (r2=0.529) during the first phase of filling cystometry. CONCLUSION: Phasic bladder compliance during the early filling phase (first filling phase) was the most representative assessment of overall bladder compliance during filling cystometry. Careful determination of early phase filling is important when seeking to acquire reliable urodynamic data on neurogenic bladders.

Amphetamine-Like Weight Reduction Drug Induced Acute Cardiomyopathy with Left Ventricular Thrombosis / 이화의대지

A 37-year-old female patient admitted due to dyspnea on exertion and peripheral edema. For one and a half years, the patient had been taking various drugs and supplements to reduce weight, including amphetamine-like drugs. The patient had no major cardiovascular risk factors except three pack-years of smoking. A chest computed tomography showed a 1.7 cm diameter, capsulated space-occupying lesion in the left ventricle (LV) and 2-dimensional echocardiography showed LV systolic dysfunction (Left ventricular ejection fraction [LVEF], 30%) with a mobile cystic mass (1.1x1.8 cm) that was attached to the LV apex, which was increased in size and number the next day, even with low dose low-molecular-weight heparin. With an increased dose of anticoagulation medication and heart failure management with diuretics and angiotensin receptor II blocker, LV dysfunction was recovered and the LV thrombus disappeared.

Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder / 감염과화학요법

Emphysematous pyelonephritis (EPN) is a rare, life-threatening complication of upper urinary tract infections that is characterized by the presence of gas in the renal parenchyma and perirenal space. It commonly occurs in diabetic patients. Escherichia coli are the most common causative organisms, with few reports implicating Citrobacter freundii as the etiologic agent in EPN. A 57-year-old woman with diabetes and neurogenic bladder visited at our department with confused mentality, myalgia, and general weakness. Further investigation revealed that the patient suffered from unilateral EPN with sepsis caused by C. freundii. The patient's condition was improved considerably with percutaneous drainage and use of intravenous antibiotics for several weeks. However, renal function eventually deteriorated to permanent renal failure, which required hemodialysis. In conclusion, C. freundii may be the causative pathogen of EPN in a patient with type 2 diabetes and neurogenic bladder.

Polypharmacy in Older Patients Admitted to a General Hospital

BACKGROUND: The elderly population is rapidly growing in numbers in Korea. According to the high prevalence of chronic disease in older persons, the issue of polypharmacy becomes one of the main problems in geriatric care. In this study, we tried to investigate the current status of inappropriate multiple drug prescriptions in older patients who were admitted to general hospital. METHODS: From July 1st 2010 to July 31th 2010, a total of 163 patients of 65 years of age or over who were admitted to one general hospital were investigated. Subjects were examined with a structured questionnaire survey. They were reviewed with medical records, and all medications taken by patients were analyzed. Inappropriate prescriptions were evaluated by Beers criteria and drug-drug interactions guidelines. RESULTS: Among the 163 participants, 146 patients took daily medication in the previous week, and the average numbers of pills taken by these patients were 7.95. 24 cases (16.4%) of inappropriate prescriptions were identified by Beers criteria, and 19 cases (13.0%) manifested a potential risk for drug-drug interaction. A total 7 cases (4.8%) of overlapping prescription of similar efficacy were also identified. Also, the risk of inappropriate prescription increased, when older patients visited 2 or more physicians (p<0.01). CONCLUSION: A considerable number of cases of prescriptions probable to cause adverse events in older patients were identified, which suggests physicians need to be thoughtful and alert for the harmful effects of polypharmacy, and the necessity of a well-structured drug monitoring system for older persons. A dedicated personal physician system for older patients should also be considered, to reduce inappropriate prescriptions.

Multi-Detector CT Findings of Primary Tubercular Appendicitis: A Case Report

The frequency of intestinal tuberculosis is relatively common; however, primary tuberculosis of the appendix remains a rarity. We report on a case of primary tuberculous appendicitis for which we obtained the MDCT images revealing thickening of the appendix and the surrounding lymphadenopathies.

Analysis of Hepatic Capsular Enhancement Mimicking the Fitz-Hugh-Curtis Syndrome on a Multidetector Computed Tomography

PURPOSE: To determine the associated diseases causing hepatic capsular enhancement and analyze the relationship of the capsular enhancement patterns as a function of the associated diseases. MATERIALS AND METHODS: We retrospectively reviewed 797 patients having undergone arterial phase abdominal CT scans. Among these images, 47 patients showed hepatic capsular enhancement (13 men and 34 women; mean age: 53.1; age range: 5-91 years). We investigated if there was a correlation between the pattern of hepatic capsular enhancement and cause of disease. When the hepatic capsular enhancement was found to persist until the portal phase, the symptom duration was evaluated. RESULTS: Hepatic capsular enhancements were presented in 5.9% (47/797) of the arterial phase abdominal CT scans. Six patients (12.8%) were diagnosed with Fitz-Hugh-Curtis syndrome. The other causes of hepatic capsular enhancement included 20 cases of inflammation, 13 cases of malignancy, and 8 cases of other diseases. The extent of the hepatic capsular enhancement was not significantly different among the causes of disease. In thirty two of 47 patients (68.1%), hepatic capsular enhancement persisted until the portal phase images. CONCLUSION: Hepatic capsular enhancement on an arterial phase is a nonspecific imaging finding observed in the Fitz-Hugh-Curtis syndrome as well as a variety of other diseases. A CT is useful in finding the hepatic capsular enhancement and determining the accompanying disease.

A Study of Electrical Middle Latency Response in a Cat: Effect of Stimulation Rate and Pulse Duration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Electrically evoked middle latency response (EMLR) has several advantages over electrically evoked auditory brainstem response (EABR). The major component peaks of EMLR lie outside the region of stimulus artifacts and it reflects the activation of a more significant portion of the auditory pathway than EABR. It is known that several conditions alter the general morphology, amplitude, and latency of the waveforms of EMLR. The purpose of this study was to record and evaluate the effects of stimulation rate and pulse duration on detectability, latency and amplitude of EMLR in the cat. MATERIALS AND METHOD: EMLR was recorded in response to 9 experimental conditions-3 conditions of pulse duration (150, 200, 250 micron sec biphasic) at each of 3 conditions of stimulation rate (2, 6 and 10/sec)-after electrical stimulation at the round window in 7 cats. RESULTS: PA was identified in all conditions. PB was obtained from 17 of the 63 waves. The latency of PA was significantly shorter and the amplitude of PA was significantly larger for the stimulation rate of 10/sec and the pulse duraion of 250 micron sec compared with other conditions. CONCLUSION: We found that based on the present data, the optimal stimultion condition for EMLR in our laboratory was the stimulation rate of 10/sec and the pulse duration of 250 micron sec. This data can provide a basis for the appropriate stimulation condition of EMLR in human.

Cerebrospinal Fluid Rhinorrhea Secondary to Acute Sphenoid Sinusitis

Acute sphenoid sinusitis is a relatively uncommon disease in the post-antibiotic era. Furthermore direct bony destruction and intracranial complications secondary to sphenoid sinusitis are extremely rare. However, it can have a high morbidity and mortality rate. If the diagnosis is delayed, serious problems can occur, so early diagnosis and treatment are required. We represent and discuss a case of cerebrospinal fluid (CSF) rhinorrhea with wide bony destruction directly, secondary to acute sphenoid sinusitis.

Relationship of the Area Measurement of the Large Endolymphatic Duct and Sac Syndrome as well as the Clinical Symptoms with CT and MR Imaging Results

PURPOSE: To evaluate the CT and MRI findings of the large endolymphatic duct or sac syndrome (LEDS) and its associated anomalies, with clinical features. MATERIALS AND METHODS: We retrospectively reviewed the MR and CT images of 52 ears obtained from 26 patients with LEDS. We reviewed the clinical findings, audiology testing, and treatment results. The degree of hearing loss was classified from normal to profound, based on pure tone audiometry. The largest areas were measured at each endolymphatic duct and analyzed to determine whether a correlation exists with the degree of hearing loss. We also analyzed the differences in measurements between CT and MRI findings. RESULTS: All 26 patients had some degree of sensorineural hearing loss, which resulted in 18 ears to undergo a cochlear implantation. One patient was diagnosed with Cornelia de Lange syndrome. Five patients had a sudden hearing loss onset. Ten ears had incomplete cochlear partitions, whereas 28 ears had enlarged vestibules. All patients had severe to profound hearing loss. We found no statistical correlation between the size of the largest area of the endolymphatic duct and the degree of hearing loss. The mean area of the endolymphatic ducts, as per an MRI examination, revealed slightly greater areas than the CT findings, although the differences were not significant. CONCLUSION: Enlarged vestibules and incomplete partitions of the cochlea were common anomalies associated with LEDS. We found no statistical correlation between the largest area of the endolymphatic duct or sac with the degree of hearing loss.

Clinical Characteristics of Pediatric Auditory Neuropathy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory neuropathy (AN) is a hearing disorder caused by desynchronous neural discharge of auditory nerve. The purpose of this study is to describe in detail various clinical manifestations of children with AN. SUBJECTS AND METHOD: The medical record of 18 children with AN were retrospectively reviewed. Demographic information, the findings of various examination including audiologic, radiologic, neurologic, and vestibular tests, and the outcomes of cochlear implantation were analyzed. RESULTS: There were 14 boys and 4 girls. The onset of hearing loss was ranged from birth to 2 years of age. Most children were diagnosed with bilateral AN based on positive otoacoustic emission (OAE) with absent ABR and they showed no changes in hearing thresholds. They had showed persistently preserved OAE and showed abnormal vestibular test results, and were not accompanied by peripheral neuropathy. In contrast, a small number of children had unilateral AN and had cochear microphonic instead of OAE. They showed changes in hearing threshold and showed disappearance of OAE, and were accompanied by peripheral neuropathy. Most children who received cochlear implants showed significant improvement in speech perception abilities. CONCLUSION: AN is a heterogeneous disorder that has some common characteristics in auditory function. Children with AN who are not benefited from appropriate auditory rehabilitation using a hearing aid can obtain significant improvement from cochlear implantation.

A Case of Dermoid Cyst in Temporal Bone / 대한이비인후과학회지

Dermoid cysts of the head and neck are rare lesions comprised of epidermal and mesodermal elements. Furthermore, dermoid cysts in the temporal bone are extremely rare. Only a few cases of dermoid cysts in the middle ear and mastoid have been reported but not yet in Korea. We report a 52-year-old male with a dermoid cyst in the left temporal bone who presented with chronic otitis media. This report describes the clinical and operative aspects of the case and provides a review of the literature.

Secondary Parkinsonism due to Extrapontine Myelinolysis without Central Pontine Myelinolysis: A case report

Parkinsonism is characterized by clinical symptoms of rigidity, bradykinesia, tremor, and gait disturbance. There are many causes of secondary parkinsonism. The present report discusses a secondary parkinsonism of extrapontine myelinolysis (EPM) without central pontine myelinolysis (CPM) after rapid correction of hyponatremia. EPM is a demyelinating process of the brain. EPM with CPM is relatively common, but EMP without CPM is rare. A 57- year-old woman with Tsutsugamushi disease had a subacuteonset of parkinsonism on the fourteenth day after a rapid correction of severe hyponatremia. Magnetic resonance imaging of the bilateral basal ganglia showed a high signal intensity on T2-weighted images, and a low signal on T1- weighted images. She was started on levodopa, and parkinsonian features slowly improved. We report an unusual case of EPM without CPM, that presented with parkinsonism.

Temporary Percutaneous Endoscopic Gastrojejunostomy : A case report

We reported a 56-year-old man who presented with vagus nerve injury after deep laceration in the neck. During being treated the neck insult, he was performed pyloplasty and vagotomy and used total parenteral nutrition due to peptic ulcer perforation and panperitonitis. He suffered from swallowing difficulty and underwent percutaneous endoscopic gastrostomy placement. As formerly, recurrent gastroesophageal reflux symptoms and gastric feeding intolerance were developed. We fixed a transgastrostomal jejunal tube in jejunum through the gastric stoma. The gastroeophageal reflux and feeding intolerance did not recur. After 30 days later, jejunal tube was removed, nutritional support was replaced by gastric tube. We were able to provide a temporary nutritional bridge with percutaneous endoscopic gastrojejunostomy placement for patients who suffered from dysphagia.

Coagulation Status of the Post-acute Spinal Cord Injured Patients

OBJECTIVE: Deep vein thrombosis (DVT) is one of the most common complications of acute spinal cord injury (SCI). It is well known that the incidence of DVT in post-acute SCI patients decreases to a level similar to that in the general population. The aim of this study was to evaluate the blood coagulation status and the possibility of DVT occurrence in post-acute SCI patients. METHOD: Twenty-three SCI patients (SCI group) were included in this study. Ten patients having spinal fracture with no evidence of SCI were used as the control group. Coagulation status was examined using factor VIII antigen, factor VIII procoagulant, fibrinogen, D-dimer, protein C, and protein S in both groups. Duplex ultrasonography was performed for the diagnosis of DVT. RESULTS: Prevalence of the abnormally decreased protein S level was significantly high in the SCI group (87%) than in the control group (30%). Prevalence of the abnormally increased F VIII:Ag, F VIII:C, and fibrinogen levels in the SCI group were significantly high in the SCI group (p<0.05). CONCLUSION: We conclude that post-acute SCI patients may have hypercoagulability. Proper physical prevention and thromboprophylaxis should be considered in post-acute SCI patients because they have relatively higher risk of thromboembolic complication.